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Purpose: This study aimed to investigate the incidence of early and late complications following treatment of patella fractures. Secondary aims were to investigate the association between early and late complications and the patient-reported outcome measurement, the Knee Injury and Osteoarthritis outcome score (KOOS). Methods: Cross-sectional study including all patients recorded with a patella fracture residing in the Northern Region of Denmark between 2010 and 2020. Early (before 3 months) and late complications were investigated by retrospective review of charts and x-rays. All patients were invited to participate in the study by reporting current knee-specific symptoms. The KOOS was used to investigate patient-reported knee-specific symptoms. Results: Seven hundred ninety-eight patients were included in the study. A total of 532 (67%) patients were treated conservatively, and 266 (33%) patients underwent surgery. The mean age at the time of fracture was 66.8, ranging from 6 to 103 years of age. The mean follow-up time was 6.4 years, ranging from 1.1 to 12.3 years follow-up. Overall, the rate of complications was 26%. Overall, the rate of complication for the surgical group was 57% and for the conservative group 4%. The most common early complication was the loss of reduction followed by the removal of symptomatic hardware. The most common late complication was the removal of symptomatic hardware and knee arthroscopy. In all the five KOOS subscales (Pain, Symptoms, ADL, Sport/Rec, and QOL), patients presenting with early and late complications reported statistically significantly worse scores than those without complications. Conclusion: The overall incidence of complications in patients presenting with a patella fracture was 26%, with a mean follow-up time of 6.4 years. In the surgical group, 57% of patients experience at least one complication during the follow-up period. Early and late complications were significantly associated with worse KOOS subscale scores. [ABSTRACT FROM AUTHOR]

Activated neutrophils release a range of inflammatory products that represent potential biomarkers, and there is interest in the prognostic value of these in acute coronary syndrome (ACS) patients. We conducted a systematic review to examine neutrophil-enriched biomarkers and the occurrence of major adverse cardiovascular events (MACE) in patients with ACS. We identified twenty-seven studies including 17,831 patients with ACS. The most studied biomarkers were neutrophil gelatinase-associated lipocalin (NGAL) and myeloperoxidase (MPO). Meta-analyses showed that elevated NGAL was associated with higher MACE rates (unadjusted risk ratio (RR) 1.52, 95% CI 1.12–2.06, p = 0.006) as were elevated MPO levels (unadjusted RR 1.61, 95% CI 1.22–2.13, p = 0.01). There was limited data suggesting that increased levels of calprotectin, proteinase-3 and double-stranded DNA were also associated with MACE. These results suggest that higher levels of neutrophil-enriched biomarkers may be predictive of MACE in patients with ACS, although higher-quality studies are needed to confirm these observations. [ABSTRACT FROM AUTHOR]

Introduction: Interpretation of patient-reported outcome scores such as the Hip Disability and Osteoarthritis Outcome Score (HOOS) can be improved with use of reference values. The aim of the study was to establish population-based reference values for the HOOS' five subscales and its short-form HOOS-12. Materials and methods: A representative sample of 9997 Danish citizens 18 years and older were identified. The population record-based sample was based on seven predefined age groups and an equal sex distribution within each age group. A national secure electronic system was used to send the HOOS questionnaire and one supplementary question regarding previous hip complaints to all participants. Results: 2277 participants completed the HOOS, 947 women (42%) and 1330 men (58%). The mean HOOS subscale scores were: pain 86.9 (95% CI 86.1–87.7), symptoms 83.7 (95% CI 82.9–84.5), ADL 88.2 (95% CI 87.5–89.0), sport and recreation function 83.1 (95% CI 82.0–84.1), QOL 82.7 (95% CI 81.8–83.6). The youngest age group reported better mean scores in four subscales compared to the oldest age group (pain 91.7 vs. 84.5, mean difference 7.2 95% CI 0.4–14.0), (ADL 94.6 points vs. 83.2, mean difference 11.4 95% CI 4.9–17.8), (sport and recreation function 91.5 points vs. 73.8 points, mean difference 17.7 95% CI 9.0–26.4), (QOL 88.9 points vs. 78.8, mean difference 10.1 points 95% CI 2.0–18.2). Participants with a self-reported hip complaint had worse HOOS scores across all subscales (mean difference range 22.1–34.6). Super obese patients (BMI > 40) had > 12.5 points worse scores across the five HOOS subscales. Results were similar for the HOOS-12. Conclusion: This study provides reference values for the HOOS and its short form HOOS-12. Results show that older patients and patients with a BMI over 40 have worse HOOS and HOOS-12 scores that may be of clinical importance in the interpretation of scores both when evaluating potential for improvement and post-treatment results. [ABSTRACT FROM AUTHOR]

The use of long-term datasets is crucial in ecology because it provides a comprehensive understanding of natural fluctuations, changes in ecosystems over extended periods of time, and robust comparisons across geographical scales. This information is critical in detecting and analysing trends and patterns in species populations, community dynamics, and ecosystem functioning, which in turn helps in predicting future changes and impacts of human activities. Additionally, long-term data sets allow for the evaluation of the effectiveness of conservation efforts and management strategies, enabling scientists and decision makers to make evidence-based decisions for biodiversity conservation. Although the use of long-term data is recognized as highly important in several scientific disciplines, its usage remains undervalued regarding questions in invasion science. Here, we used four regional subsets (i.e. England, Hungary, Denmark and the Dutch-German-Luxembourg) of a recently collated long-term time series database to investigate the abundance and dynamics of occurring non-native species over space and time in Europe. While we found differences in the numbers of non-native species across the studied regions (Dutch-German-Luxembourg region = 37; England = 17, Hungary = 34; Denmark = 3), non-native species detection rates were continuous over time. Our results further show that long-term monitoring efforts at large spatial scales can substantially increase the accuracy and rate at which non-native species are detected. This information can inform management endeavours dealing with non-native species, underlining the need for invasion scientists and authorities-stakeholders to make more effort in collecting, analysing and making available long-term datasets at broader geographic ranges. [ABSTRACT FROM AUTHOR]

Technological and computational advancements in the fields of genomics and bioinformatics are providing exciting new opportunities for pathogen discovery and genomic surveillance. In particular, single-molecule nucleotide sequence data originating from Oxford Nanopore Technologies (ONT) sequencing platforms can be bioinformatically leveraged, in real-time, for enhanced biosurveillance of a vast array of zoonoses. The recently released nanopore adaptive sampling (NAS) strategy facilitates immediate mapping of individual nucleotide molecules to a given reference as each molecule is being sequenced. User-defined thresholds then allow for the retention or rejection of specific molecules, informed by the real-time reference mapping results, as they are physically passing through a given sequencing nanopore. Here, we show how NAS can be used to selectively sequence DNA of multiple bacterial tick-borne pathogens circulating in wild populations of the blacklegged tick vector, Ixodes scapularis. [ABSTRACT FROM AUTHOR]

Introduction: At present, limited knowledge regarding clinical, functional, and patient-reported outcomes at mid- and long-terms after surgical treatment of traumatic knee dislocations is available. This study aimed to investigate the mid-term recovery regarding clinical, functional, and patient-reported outcomes in patients following knee dislocation with associated multi-ligament injuries. Materials and methods: The study design was a cross-sectional cohort study. Data were collected by retrospective chart review, clinical examination, and interview of patients. All patients treated surgically following a knee dislocation between January 2000 and December 2011 were included. The surgical technique was up to the decision of the individual surgeon. The main outcome was the Lysholm knee score. Secondary outcomes consist of clinical knee examination, functional performance test, pain, and patient-reported outcome across several domains in function, sport, pain, and quality of life. Results: Seventy-five patients (66.3%) accepted the invitation to participate. The mean age at the time of knee dislocation was 33.5 years, with a range of 16–65 years of age. The mean follow-up time was 78 months (R: 17–147). 75% of patient a Schenck's type 1 lesion and 23% a type 3. The median Lysholm knee score was 83 (R: 18–100). The mean KOOS for the five subscales were pain 84.5 (95% CI 80.5–88.5), symptoms 75.1 (95% CI 70.7–79.4), ADL 87.0 (95% CI 83.1–90.9), sport 59.9 (95% CI 53.3–66.4), and QOL 71.3 (95% CI 67.0–75.6). The mean Tegner activity level was 5.1 (95% CI 4.5–5.7). The median single assessment numeric evaluation (SANE) was 93 (R: 0–100). The pain intensity score for pain (VAS) during activity was reported with a mean of 2.7 (95% CI 2.1–3.3). The objective IKDC examination showed 76% of patients grouped by Grade A (normal knee function) or Grade B (nearly normal). Conclusion: With a mean follow-up of 6.5 years, combined repair and reconstruction surgery following a knee dislocation shows good to excellent patient-reported outcome and more than 75% of patients experiencing normal knee functioned evaluated by the IKDC score. [ABSTRACT FROM AUTHOR]

The clinical utility of combining extracellular matrix (ECM) biomarkers to predict the development of impaired systolic function following acute myocardial infarction (AMI) remains largely undetermined. A combination of ELISA and multiplexing assays were performed to measure matrix metalloproteinase (MMP)-2, MMP-3, MMP-8, MMP-9, periostin, N-terminal type I procollagen (PINP) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in plasma samples from 120 AMI patients. All patients had an echocardiogram within 1 year of AMI, and were divided into impaired (n = 37, LVEF < 50%) and preserved (n = 83, LVEF ≥ 50%) systolic function groups. Exploratory factor analysis was performed on log-transformed biomarkers using principle axis analysis with Oblimin rotation. Cluster analysis was performed on log-transformed and normalised biomarkers using Ward's method of minimum variance and the squared Euclidean distance metric. Upon univariate analysis, current smoking, prescription of ACE inhibitors at discharge, peak hsTnT > 610 ng/L (median), MMP-8 levels, Factor 1 scores and Cluster One assignment were predictive of impaired systolic function. Upon multivariate analysis, Cluster One assignment (odds ratio [95% CI], 2.74 [1.04–7.23], p = 0.04) remained an independent predictor of systolic dysfunction in combination with clinical variables. These observations support the usefulness of combining ECM biomarkers using cluster analysis for predicting the development of impaired systolic function in AMI patients. [ABSTRACT FROM AUTHOR]

Purpose: The primary aim of the present study was to compare basic characteristics of patients requiring early treatment with TKR and patients not requiring TKR within 3 years following a lateral tibial plateau fracture. Methods: Comparative cohort study. From December 2013 to November 2016, 56 patients were included. Five patients required a TKR within the first 3 years. We compared the basic characteristics (age, gender, BMI, comorbidity, osteoporosis, fracture classification, soft tissue injuries and trauma mechanism) between patients. Results: Comparing baseline characteristics of the two groups of patients shows a higher rate of females (56.4% vs 80%), a higher BMI (25.9 vs 29.9), a higher rate of patients with diabetes (8% vs 20%), a higher rate of the fracture type AO 41-B1 (8% vs 80%) and a higher rate of soft tissue injuries (46% vs 100%). Age, smoking status and preoperative maximum joint depression were comparable between the two groups. Conclusions: Female gender, severe comorbidity, obesity, osteopenia, fracture type AO 41-B and soft tissue injuries were associated to early total knee replacements following surgically treated lateral tibial plateau fractures. [ABSTRACT FROM AUTHOR]

Introduction: Splice modulators have been assessed clinically in treating haematologic malignancies exhibiting splice factor mutations and acute myeloid leukaemia. However, the mechanisms by which such modulators repress leukaemia remain to be elucidated.Objectives: The primary goal of this assessment was to assess the molecular mechanism by which the natural splice modulator GEX1A kills leukaemic cells in vitro and within in vivo mouse models.Methods: Using human leukaemic cell lines, we assessed the overall sensitivity these cells have to GEX1A via EC50 analysis. We subsequently analysed its effects using in vivo xenograft mouse models and examined whether cell sensitivities were correlated to genetic characteristics or protein expression levels. We also utilised RT-PCR and RNAseq analyses to determine splice change and RNA expression level differences between sensitive and resistant leukaemic cell lines.Results: We found that, in vitro, GEX1A induced an MCL-1 isoform shift to pro-apoptotic MCL-1S in all leukaemic cell types, though sensitivity to GEX1A-induced apoptosis was negatively associated with BCL-xL expression. In BCL-2-expressing leukaemic cells, GEX1A induced BCL-2-dependent apoptosis by converting pro-survival BCL-2 into a cell killer. Thus, GEX1A + selective BCL-xL inhibition induced synergism in killing leukaemic cells, while GEX1A + BCL-2 inhibition showed antagonism in BCL-2-expressing leukaemic cells. In addition, GEX1A sensitised FLT3-ITD+ leukaemic cells to apoptosis by inducing aberrant splicing and repressing the expression of FLT3-ITD. Consistently, in in vivo xenografts, GEX1A killed the bulk of leukaemic cells via apoptosis when combined with BCL-xL inhibition. Furthermore, GEX1A repressed leukaemia development by targeting leukaemia stem cells through inhibiting FASTK mitochondrial isoform expression across sensitive and non-sensitive leukaemia types.Conclusion: Our study suggests that GEX1A is a potent anti-leukaemic agent in combination with BCL-xL inhibitors, which targets leukaemic blasts and leukaemia stem cells through distinct mechanisms. [ABSTRACT FROM AUTHOR]

Diagnostic tools for the detection of protein-misfolding diseases (i.e., proteopathies) are limited. Gold nanoparticles (AuNPs) facilitate sensitive diagnostic techniques via visual color change for the identification of a variety of targets. In parallel, recently developed quaking-induced conversion (QuIC) assays leverage protein-amplification and fluorescent signaling for the accurate detection of misfolded proteins. Here, we combine AuNP and QuIC technologies for the visual detection of amplified misfolded prion proteins from tissues of wild white-tailed deer infected with chronic wasting disease (CWD), a prion disease of cervids. Our newly developed assay, MN-QuIC, enables both naked-eye and light-absorbance measurements for detection of misfolded prions. MN-QuIC leverages basic laboratory equipment that is cost-effective and portable, thus facilitating real-time prion diagnostics across a variety of settings. In addition to laboratory-based tests, we deployed to a rural field-station in southeastern Minnesota and tested for CWD on site. We successfully demonstrated that MN-QuIC is functional in a non-traditional laboratory setting by performing a blinded analysis in the field and correctly identifying all CWD positive and CWD not-detected deer at the field site in 24 h, thus documenting the portability of the assay. White-tailed deer tissues used to validate MN-QuIC included medial retropharyngeal lymph nodes, parotid lymph nodes, and palatine tonsils. Importantly, all of the white-tailed deer (n = 63) were independently tested using ELISA, IHC, and/or RT-QuIC technologies and results secured with MN-QuIC were 95.7% and 100% consistent with these tests for positive and non-detected animals, respectively. We hypothesize that electrostatic forces help govern the AuNP/prion interactions and conclude that MN-QuIC has great potential for sensitive, field-deployable diagnostics for CWD, with future potential diagnostic applications for a variety of proteopathies. [ABSTRACT FROM AUTHOR]

Zoonotic disease risk is greatly influenced by cultural practices and belief systems. Yet, few studies have investigated how different ways of knowing are commensurate with one another in the context of zoonotic disease. By stressing methodological pluralism and explicitly challenging the nature-culture dichotomy, an ethnoprimatological approach is particularly well suited to bridging different ontologies for understanding zoonotic transmission. We seek to integrate molecular phylogenetics, histopathology, and ethnography to characterize a filarial nematode found within the abdominal cavity of spider monkeys (Ateles paniscus). The filarid is recognized as "spider monkey cotton" by Indigenous Waiwai in the Konashen Community Owned Conservation Area, Guyana. Ethnographic data revealed that the Waiwai perceive of "spider monkey cotton" as a normal characteristic within the "spider monkey person." Furthermore, the Waiwai indicated that "cotton" was ubiquitous with spider monkeys and is not understood to be infectious nor zoonotic. This distinction is in contrast to other internal parasites found within spider monkeys that the Waiwai believe cause disease in both monkeys and humans. Our morphological and molecular characterization support the classification of the filarid as Dipetalonema caudispina, a minimally studied, nonzoonotic parasite. While this identification contrasts with Waiwai understanding of the filarid as a component of the spider monkey itself, the ubiquity of the filarid in spider monkeys in the region and its nonzoonotic nature suggest scientific knowledge and Waiwai ontology are commensurate. More broadly, this work highlights the importance of integrating multiple knowledge systems and leveraging advanced genomics to better understand and prevent emerging zoonotic diseases. [ABSTRACT FROM AUTHOR]

Introduction: Tibial intercondylar eminence fracture is a rare fracture and is commonly treated with suture, screw or bio-absorbable nail. Current literature includes little information regarding outcome of surgically treatment with bio-absorbable nails. The purpose of this study was to report the clinical and functional outcomes in patients with tibial intercondylar eminence fractures arthroscopically treated with bio-absorbable nails. Methods: The study design was retrospective follow-up. Sixteen patients, age 11–16 years, were surgically treated with bio-absorbable nail following an intercondylar eminence fracture. Thirteen patients participate in the present follow-up study. The median follow-up time was 6.5 years. The main outcome measurement was the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcome measurements consisted of: Eq5d-5L questionnaire, knee pain, knee laxity, range of motion (ROM), muscle strength, gait analyses, radiological outcomes, activity and level. Results: The median KOOS scores for the five subscales were: pain 98.5 (19–100), symptoms 90.5 (54–100), ADL 100 (22–100), sport 87.5, (0–100) and QOL 88.0 (13–100), indication satisfactory outcome. Low level of gait asymmetry was observed. Almost balanced muscle strength between the injured and non-injured leg for knee extension and knee flexion strength was observed. Measurement of anterior knee laxity showed 12 patients with a knee laxity between − 1 and 2 mm. The examination of intercondylar eminence displacement at the time of follow-up showed that 12 patients had a displacement of 2 mm or less. Conclusion: This case series demonstrates satisfactory patient-reported and functional outcomes in the treatment of intercondylar eminence fractures in children and adolescents with bio-absorbable nails. [ABSTRACT FROM AUTHOR]

Background/aims: Although volumetric imaging by computed tomography (CT) is the gold standard for preoperative assessment of the future liver remnant, nuclear imaging studies have shown promising data. This systematic review summarized the results from trials investigating volumetric and nuclear medicine imaging for the prediction of postoperative mortality and liver failure (LF). Methods: MEDLINE and Web of Science were searched for papers investigating nuclear imaging methods for the prediction of postoperative clinical outcomes in patients undergoing local, liver-directed treatments. Only papers investigating both preoperative nuclear imaging and CT or magnetic resonance imaging (MR) for the prediction of postoperative mortality and/or LF were included. Results: Twenty-five trials were qualified for this review. All trials but two used technetium-based tracers for the nuclear imaging examination. Four papers used MR imaging and the remaining used CT for the volumetric evaluation. Overall, the studies were heterogeneous both in terms of methodology and imaging technique. Of the thirteen studies reporting on postoperative mortality, most were descriptive without detailed diagnostic data. A few with detailed data found that nuclear imaging had better predictive value than volumetric imaging. Nineteen studies investigated the prediction of postoperative LF of which seven papers investigated the predictive value of both modalities in multivariable regression analysis. Two papers found that only nuclear imaging parameters were predictive of LF, one paper found that the CT parameter was predictive, and four papers found that combined nuclear and CT/MR imaging parameters were predictive of LF. Conclusion: Both methodologies were useful in the preoperative assessment of patients scheduled for liver interventions, especially in combination, but nuclear imaging demonstrated better predictive value for postoperative mortality and LF in a few trials. The overall technical and methodological heterogeneity of the included studies complicates the ability to directly compare the clinical utility of the two imaging techniques. [ABSTRACT FROM AUTHOR]

Chronic wasting disease (CWD) is a prion disease circulating in wild and farmed cervid populations throughout North America (United States and Canada), Europe (Finland, Norway, Sweden), and South Korea. CWD is a long-term threat to all cervid populations and to cervid hunting heritage, with the potential to cause substantial economic losses across multiple sectors. In North America, hunting and farming industries focused on the processing and consumption of white-tailed deer (WTD) venison are particularly vulnerable to CWD prion contamination, as millions of WTD are consumed annually. Real-time quaking-induced conversion (RT-QuIC) is a highly sensitive assay amplifying misfolded CWD prions in vitro and has facilitated CWD prion detection in a variety of tissues and excreta. To date, no study has comprehensively examined CWD prion content across bulk skeletal muscle tissues harvested from individual CWD infected WTD. Here, we use RT-QuIC to characterize prion-seeding activity in a variety of skeletal muscles from both wild and farmed CWD-positive WTD. We successfully detected CWD prions in muscles commonly used for consumption (e.g., backstrap, tenderloin, etc.) as well as within tongue and neck samples of WTD. Our results suggest that CWD prions are distributed across the skeletal muscles of infected WTD. We posit that RT-QuIC will be a useful tool for monitoring CWD prions in venison and that the method (with additional protocol optimization and high-throughput functionality) could be used to reduce and/or prevent CWD prions from entering animal and human food chains. [ABSTRACT FROM AUTHOR]

Introduction: Although a large number of previous studies have investigated the outcome in patients following tibial shaft fractures, the literature provides limited information on prospectively reported patients with mid- to long-term follow-up. The present study aimed to investigate prospectively the 5-year development in patient-reported quality of life after intramedullary nailing of a tibial shaft fracture. Material and methods: The design was a prospective, 5-year follow-up cohort study. Quality of life (QOL) was measured with the questionnaire Eq5d-5L and compared to the 1-year outcome reported by the same patients. Secondary outcome measurements were the Knee Injury and Osteoarthritis Outcome Score (KOOS), recordings of pain, gait and muscle strength. Results: Twenty-nine patients were eligible for participation. Mean patient age at the time of the 5-year follow-up was 46.3 years. The 5-year postoperative mean Eq5d-5L index was 0.864 (95% CI 0.809–0.918). The mean Eq5d-5L VAS was 88.4 (95% CI 83.4–93.5). Compared with the same patients' Eq5d-5L index scores at the 1-year follow-up (0.784), a significant increase was observed (P = 0.014). A comparison to the Danish Eq.5D reference population showed no statistically significant difference. Conclusions: Patient-reported quality of life among patients treated with intramedullary nailing following a tibial shaft fracture increased significantly between the 1-year and 5-year follow-up. In contrast to the 1-year patient-reported quality of life, results are comparable to those of a reference population at the 5-year follow-up. In a clinical setting, these results highlight that patients may expect a prolonged period to recover. However, of most importance is that patients can expect a satisfactory outcome years after fracture and treatment. [ABSTRACT FROM AUTHOR]

A 5-min 12-lead ECG was recorded (sampled at 500 Hz, SE-1010 PC ECG system), ensuring a stable 60-s section was available. ECG data for both groups were analyzed and reported by maximum and integral QRS-T angles, duration of analysis section and heart rate to enable comparisons between them, with analysis blind to group allocation. In conclusion, this pilot study shows increased QRS-T vector angle may be associated with poorer glycemic control in children and adolescents with T1D, suggesting repolarization abnormalities may result from suboptimal control. [Extracted from the article]

Extracellular matrix (ECM) biomarkers are useful for measuring underlying molecular activity associated with cardiac repair following acute myocardial infarction (AMI). The aim of this study was to conduct exploratory factor analysis (EFA) to examine the interrelationships between ECM biomarkers, and cluster analysis to identify if distinct ECM profiles could distinguish patient risk in AMI. Ten ECM biomarkers were measured from plasma in 140 AMI patients: MMP-2, -3, -8, -9, periostin, procollagen I N-Terminal propeptide, osteopontin, TGF-β1, TIMP-1 and -4. EFA grouped eight ECM biomarkers into a two-factor solution, which comprised three biomarkers in Factor 1 and five biomarkers in Factor 2. Notably, ECM biomarkers were not separated based on biological function. Cluster analysis grouped AMI patients into three distinct clusters. Cluster One (n = 54) had increased levels of MMP-8, MMP-9, and TGF-B1. Cluster Two (n = 43) had elevated levels of MMP-2, MMP-3, osteopontin, periostin and TIMP-1, and increased high-sensitivity troponin T and GRACE scores. Cluster Three (n = 43) had decreased levels of ECM biomarkers. Circulating ECM biomarkers demonstrated collinearity and entwined biological functions based on EFA analysis. Using cluster analysis, patients with similar clinical presentations could be separated into distinct ECM profiles that were associated with differential patient risk. Clinical significance remains to be determined. [ABSTRACT FROM AUTHOR]

Echinococcus spp. are zoonotic cestode parasites with a worldwide distribution and a complex, two-host life cycle involving carnivore definitive hosts and small mammal or ungulate intermediate hosts. Surveillance for Echinococcus spp. in the Midwestern United States (USA) is rare. Using a mixed-methods approach, we examined Echinococcus infection risks in wildlife and domestic dogs in four Minnesota Tribal Nations. We hypothesized that the spillover of Echinococcus spp. into domestic dogs would vary with the presence or absence of suspected wildlife host species and certain behaviors associated with domestic dog ownership, like feeding wildlife host carcasses or frequency of veterinary care. Among 83 dogs tested, three (3.6%) were positive for Echinococcus spp. Despite low prevalence, pet owner survey and focus group findings indicated that dogs encounter peri-domestic wildlife most often when they roam freely or consume wildlife carcasses. This study demonstrates a need for further research into spillover potential of endemic zoonotic Echinococcus spp. in the Midwest USA. [ABSTRACT FROM AUTHOR]

The segregation of solute atoms at grain boundaries (GBs) can profoundly impact the structural properties of metallic alloys, and induce effects that range from strengthening to embrittlement. And, though known to be anisotropic, there is a limited understanding of the variation of solute segregation tendencies across the full, multidimensional GB space, which is critically important in polycrystals where much of that space is represented. Here we develop a machine learning framework that can accurately predict the segregation tendency—quantified by the segregation enthalpy spectrum—of solute atoms at GB sites in polycrystals, based solely on the undecorated (pre-segregation) local atomic environment of such sites. We proceed to use the learning framework to scan across the alloy space, and build an extensive database of segregation energy spectra for more than 250 metal-based binary alloys. The resulting machine learning models and segregation database are key to unlocking the full potential of GB segregation as an alloy design tool, and enable the design of microstructures that maximize the useful impacts of segregation. Predicting segregation energies of alloy systems can be challenging even for a single grain boundary. Here the authors propose a machine-learning framework, which maps the local environments on a distribution of segregation energies, to predict segregation energies of alloy elements in polycrystalline materials. [ABSTRACT FROM AUTHOR]

In modern software development, the practices of continuous integration and DevOps are widely used to increase delivery speed and reduce the time it takes to deploy software changes to production. If formal method tools cannot be efficiently integrated in a DevOps paradigm, then their impact on software development will be reduced. In this paper, we present work addressing this issue through a series of extensions for the Overture tool supporting the Vienna Development Method. These extensions enable Overture to be used in a DevOps setting, through continuous integration and validation of models and generated code via integration with the Jenkins automation server. We frame the integration of formal methods and DevOps in a series of principles, demonstrate the value of this integration through a case study, and reflect on our experiences using formal methods and DevOps in an industrial setting. We hope that this work can help other formal method practitioners integrate their tools with DevOps. [ABSTRACT FROM AUTHOR]

Introduction: Disregarding proximal femoral fractures, the current literature includes only limited information regarding mortality following lower extremity fractures. Information regarding risk of mortality related to specific fracture patterns is essential when planning treatment modalities. The primary aim of this study was to report the long-term cumulative survival rate in patients with a tibial plateau fracture compared to an age- and gender-matched reference population. Materials and methods: Patients who sustained a tibial plateau fracture in Denmark between 1996 and 2000 were included in the study. Survival status was monitored until 2015. We compared the mortality rate with a tenfold reference population matched on age and gender without a prior tibial plateau fracture. The study was based on register data from the Danish National Patient Register. Results: The study included 7950 patients sustaining 8065 tibial plateau fractures. The cohort had a mean follow-up period of 13.9 years. Patients with a tibial plateau fracture had a 1.52 (95% CI 1.46–1.58) times higher hazard ratio (HR) of death compared to the age- and gender-matched reference population. The 30-day, 6-month and 1-year mortality rates were 1.2%, 3.3% and 4.9%, respectively. Conclusion: Patients with a proximal tibial plateau fracture have a higher cumulative risk of death during the mean 13.9-year observational period compared to an age- and gender-matched reference population. [ABSTRACT FROM AUTHOR]

Madagascar is a biodiversity hotspot that is facing rapid rates of deforestation, habitat destruction, and poverty. Urgent action is required to document the status of biodiversity to facilitate efficacious conservation plans. With the recent advent of portable and affordable genetic technologies, it is now possible to take genomic approaches out of the lab and into the field. Mobile genetics labs can produce scientifically reproducible data under field conditions, dramatically minimizing the time between sample collection and data analysis. Here, we show "proof of concept" by deploying miniPCR bio's miniaturized thermal cycler alongside Oxford Nanopore's MinION DNA sequencer in Madagascar. Specifically, we deployed this technology at Anjajavy, northwestern Madagascar for rapid biodiversity assessment. We successfully extracted mouse lemur DNA, amplified and sequenced a phylogenetically informative mitochondrial gene (cytochrome-b; cytb), and thereby confirmed the presence of Danfoss' mouse lemur (M. danfossi) within the Anjajavy Reserve. We show that a mobile genetics lab can provide expeditious results, and allow scientists to conduct genetic analyses, potentially allowing for rapid interventions under emergency conditions in situ. Additionally, mobile labs offer powerful training opportunities for in-country scientists for whom training opportunities were previously confined to ex-situ locations. By bringing genomic technologies to Madagascar and other economically challenged and biodiverse regions of the world, the next generation of scientists and conservationists can more fully implement their leadership roles. Local laboratory and training facilities are changing the polarity of research programs in Madagascar and empowering national researchers to take charge of environmental stewardship. [ABSTRACT FROM AUTHOR]

Thermal methods are indispensable for the characterization of most materials. However, the existing methods require bulk amounts for analysis and give an averaged response of a material. This can be especially challenging in a biomedical setting, where only very limited amounts of material are initially available. Nano- and microelectromechanical systems (NEMS/MEMS) offer the possibility of conducting thermal analysis on small amounts of materials in the nano-microgram range, but cleanroom fabricated resonators are required. Here, we report the use of single drug and collagen particles as micro mechanical resonators, thereby eliminating the need for cleanroom fabrication. Furthermore, the proposed method reveals additional thermal transitions that are undetected by standard thermal methods and provide the possibility of understanding fundamental changes in the mechanical properties of the materials during thermal cycling. This method is applicable to a variety of different materials and opens the door to fundamental mechanistic insights. Eliminating the need for cleanroom fabrication for thermomechanical characterization of organic samples in a biomedical setting remains a challenge. Here, the authors propose the use of a single drug and collagen particles as resonators, enabling direct measurements on a material during thermal cycling. [ABSTRACT FROM AUTHOR]

Purpose: What are the overall, 30-day, 6-month, and 1-year mortality rates following distal femur fractures?Methods: Epidemiological cohort study. Retrospective reviews of charts and X-rays based on a search in the National Danish Health Registry.Results: A total of 293 patients were treated for 302 distal femur fractures between 2005 and 2010. The mean age at the time of fracture was 44.0 years for males and 71.6 years for females. The overall mortality rates after a non-periprosthetic distal femur fracture at 30 days, six months, and one year were 5%, 15%, and 21%, respectively. The mortality rates for patients at > 60 years at 30 days, six months, and one year were 8%, 26%, and 35%, respectively. The mortality rates for patients at ≤ 60 years at 30 days, six months, and one year were 1%, 2%, and 3%, respectively. The overall mortality rates after a periprosthetic distal femur fracture at 30 days, six months, and one year were 10%, 15%, and 15%. Males were 2.6 (95% CI 1.01-6.86, P = 0.04) times more likely to die within the first year compared to women. Patients treated by conservative means shows a 2.8 (95% CI 1.41-5.54, P = 0.03) times increased likelihood of death within the first year compared to patients treated with surgery.Conclusions: The overall one year mortality rate was 21% for non-periprosthetic distal femur fractures and was elevated to 35% in patients older than 60 years. Patients presenting with a periprosthetic fracture showed a one year mortality rate of 15%. [ABSTRACT FROM AUTHOR]

Developing embedded systems that are distributed is a challenging endeavour, since they need to ensure system-wide properties as well as existence of a large number of possible candidate system architectures. Various model based techniques advocate raising the abstraction level in order to support a holistic view of such a distributed embedded system. Furthermore, automatically generating implementation specific code from models can support realisation efforts including avoiding inconsistencies between model and code. In this paper we present how such efforts can be aided for a distributed embedded system modelled in the real time dialect of the Vienna Development Method, VDM-RT, by means of automatic code generation. The contributions in this paper are (1) code generation capabilities for distributed embedded system modelled in VDM-RT; (2) demonstration of its applicability for an industrial case study involving a distributed interlocking system from the railways domain. Additionally, we discuss the balance between code generation for a model, which assumes idealised communication (no messages lost), and manually produced code, e.g. in the industrial case study legacy low-level code ensures fault-tolerant communication in the final implementation. [ABSTRACT FROM AUTHOR]

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Accurate and precise documentation of lesions is an important aspect of the forensic pathologists' work. Photogrammetry provides a useful tool to take precise measurements from photographs. These photographs are normally acquired with single camera photographs, but the procedure is quite time-consuming. Video recording has the potential to record a larger amount of image data faster. We documented 33 cadaveric skin lesions, using photographs and video recordings. The dimensions of the lesions ranged between 0.27 and 21.8 cm. The measurements of the lesions were extracted with both manual and automatic point measurements from photographs and from video frames, respectively. Very small differences (mean and median < 1 mm) were found between measurements taken in photographs versus video frames. Video frames were often blurred, preventing clear demarcation of the edges of the lesions and presenting a larger amount of noise in the 3D models. The differences between the manual point and automatic point measurements were very small (mean and median < 1 mm), but the manual procedure is to be preferred, since automatic points were not always located on the edges of the lesions. The only aspect in which video frames were superior to photographs was the recording time: video recording was almost five times faster than the photo sessions. In conclusion, this study shows that precise and comparable measurements can be extracted both from photographs and video frames. The video is the fastest method, but the use of photographs is still recommended. Manual measurements are more precise than automatic measurements and equally time-consuming. [ABSTRACT FROM AUTHOR]

The US energy services company (ESCO) industry is an example of a private-sector business model that delivers energy savings to customers primarily through the use of performance-based contracts. US ESCO projects garner significant incremental annual savings: approximately 1% of total US commercial building consumption in 2014. From 2000 to 2011, the industry experienced year over year growth; however, based on information drawn from interviews with ESCO executives conducted in late 2015, the authors find that from 2012 to 2014, ESCO industry revenues did not increase. While public and institutional market sectors accounted for 85% of industry revenue in 2014, consistent with previous research findings, the share of revenue from performance contracting increased to 74% in 2014, as compared to 69% share reported for 2011 and 2008. The revenue numbers between 2011 and 2014 are not fully comparable, because a few ESCOs that were subsidiaries of larger companies had undergone reorganization and some categories of revenue reported in 2011 were not included for 2014. Other factors that may have contributed to the recent revenue trend include the following: (1) increased competition from companies not historically defined as an ESCO (e.g. mechanical contractors), (2) uncertainty among some potential customers about committing to long-term performance contracts, and (3) reduction of performance contracting’s perceived benefit of hedging energy price increases and variability due to customer expectations of continued low and less volatile energy prices. [ABSTRACT FROM AUTHOR]

Background: Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and decrease morbidity and hospital stay in several major surgical procedures. The aim of this study was to investigate the effect over time of a modified previously published fast-track programme in unselected patients undergoing open or laparoscopic liver resection.Methods: A prospective study includes the first 121 consecutive patients following an updated fast-track programme for liver resection. High-dose methylprednisolone was given to all patients before surgery, catheters and drains were systematically removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. The discharge criteria were (1) pain sufficiently controlled by oral analgesics only; (2) patient comfortable with discharge; (3) no untreated complications.Results: The median length of stay (LOS) for all patients was 4 days, with 2 days after laparoscopic vs. 4 days for open resections. The median LOS after major hepatectomies (≥3 segments) was 5 days. The readmission rate was 6% and the 30-day mortality zero. The LOS decreased compared to our first-generation fast-track programme with LOS 5 days.Conclusions: Fast-track principles for perioperative care and early discharge are safe even after major liver resection. The introduction of high-dose steroids preoperatively might have facilitated a shorter LOS. Routine discharge on POD 1 or 2 after laparoscopic resection and on POD 4 after open liver resection has proven to be feasible. [ABSTRACT FROM AUTHOR]

When a system specified using the Vienna Development Method (VDM) is realised using code-generation, no guarantees are currently made about the correctness of the generated code. In this paper, we improve codegeneration of VDM models by taking contract-based elements such as invariants and pre- and postconditions into account during the code-generation process. The contractbased elements of the Vienna Development Method Specification Language (VDM-SL) are translated into corresponding constructs in the Java Modelling Language (JML) and used to validate the generated code against the properties of the VDM model. VDM-SL and JML are both Design-by-Contract (DbC) languages, with the difference that VDM-SL supports abstract modelling and system specification, while JML is used for detailed specification of Java classes and interfaces. We describe the semantic differences between the contract-based elements of VDMSL and JML and formulate the translation as a set of rules. We further demonstrate how dynamic JML assertion checks can be used to ensure the consistency of VDM's subtypes when a model is code-generated. The translator is fully automated and produces JML-annotated Java programs that can be checked for correctness using JML tools. [ABSTRACT FROM AUTHOR]

The long-term outcomes following complex fractures of the tibia are reported to carry a risk of knee pain, malalignment, articular injury and post-traumatic osteoarthritis. The main objective of this study was to account for the patient-reported quality of life (QOL) 12 months after ring fixator removal in patients with a complex tibial fracture. Secondary objectives included a review of the socio-economic characteristics of the patient group and the rate of return to work in the study period. A prospective follow-up study was conducted of 60 patients with complex fractures of the tibia treated with ring external fixation. Patient-reported outcomes, radiological outcomes and socio-economic status including employment status of the patients were obtained 12 months after frame removal. Forty-six patients completed the assessment 12 months after frame removal (77%). The mean age of the patient at the time of fracture was 54.6 years (range 31-86). There were 19 males and 27 females. At 12 months after frame removal, the mean EQ5D-5L index was 0.66 (CI 0.60-0.72). The mean EQ5D-5L VAS was 69 (CI 61-76). When this was compared to the established reference population from Denmark, the study population showed a significantly worse EQ5D-5L index. The majority of patients (87%) were in the lower social classes suggesting a higher degree of social deprivation in the study population. Twenty-seven per cent of patients who were employed prior to injury had returned to employment at approximately 19 months following fracture. The onset of post-traumatic osteoarthritis was present in the knee joint in 29% of patients following a proximal intra-articular fracture, whereas osteoarthritis was present at the ankle joint in 35% of patients following a distal intra-articular fracture 12 months after frame removal. This study indicates that at 12 months after frame removal there are poorer patient-reported QOL as when compared to reference populations. Furthermore, this study suggests that complex tibial fractures are associated with lower social classes and that only 27% of patients in this sample, who prior to injury were employed, had returned to employment at approximately 19 months after the injury. [ABSTRACT FROM AUTHOR]

Alu elements are a highly successful family of primate-specific retrotransposons that have fundamentally shaped primate evolution, including the evolution of our own species. Alus play critical roles in the formation of neurological networks and the epigenetic regulation of biochemical processes throughout the central nervous system (CNS), and thus are hypothesized to have contributed to the origin of human cognition. Despite the benefits that Alus provide, deleterious Alu activity is associated with a number of neurological and neurodegenerative disorders. In particular, neurological networks are potentially vulnerable to the epigenetic dysregulation of Alu elements operating across the suite of nuclear-encoded mitochondrial genes that are critical for both mitochondrial and CNS function. Here, we highlight the beneficial neurological aspects of Alu elements as well as their potential to cause disease by disrupting key cellular processes across the CNS. We identify at least 37 neurological and neurodegenerative disorders wherein deleterious Alu activity has been implicated as a contributing factor for the manifestation of disease, and for many of these disorders, this activity is operating on genes that are essential for proper mitochondrial function. We conclude that the epigenetic dysregulation of Alu elements can ultimately disrupt mitochondrial homeostasis within the CNS. This mechanism is a plausible source for the incipient neuronal stress that is consistently observed across a spectrum of sporadic neurological and neurodegenerative disorders. [ABSTRACT FROM AUTHOR]

Purpose: The literature lacks recent epidemiological studies on the incidence, trauma mechanism and fracture classification of distal femur fractures. The aim of the present study was to provide up-to-date information concerning the incidence of distal femur fractures in a large and complete population and to report on the distribution of fracture classification, trauma mechanisms and patient baseline demographics.Methods: The approach for this study was via a retrospective reviews of records.Results: A total of 293 patients were treated for 302 distal femur fractures between 2005 and 2010. The mean age at the time of fracture was 62.2 years. The mean age was 44.0 years for males and 71.6 years for females. The gender distribution was 33.4% males and 66.6% females. The overall incidence of distal femur fractures was 8.7/100,000/year. After the age of 60 years, a rapid increase in the incidence of distal femoral fractures was observed in both genders, with a large female predominance. Low-energy injuries were the most common mode of injury in both genders (97%), with approximately 61% being the result of a fall from standing height. AO classification type A (extra-articular fractures) was the most common of all fractures (38.6%). Eighty-four patients (28.7%) were admitted with periprosthetic fractures, corresponding to an overall incidence of periprosthetic fractures of 2.4/100,000/year.Conclusions: The present study shows an incidence of 8.7/100,000/year of distal femur fractures. After the age of 60 years, a rapid increase in the incidence of distal femoral fractures was observed in both genders, with a considerable female predominance. [ABSTRACT FROM AUTHOR]

The objective of this prospective study was to evaluate the patient-reported outcomes for patients with complex tibial fractures treated with a ring fixator. The secondary aim was to analyse the variables affecting patient-reported outcomes and time to union. Fifty-six patients participated in the study. The mean age at the time of fracture was 56.5 years (range 30-86). All fractures united during the study period. The ring fixator was removed at an average of 25.3 weeks (range 9-53). During treatment, the function and QOL increased with time. Compared with an established reference population, the study population showed a significantly worse EQ5D-5L index both throughout the treatment period and 8 weeks after frame removal. 18% of patients reported mild to severe depression 8 weeks after frame removal. [ABSTRACT FROM AUTHOR]

Introduction: Most studies of polytrauma examined highly mixed patient groups. The objective of the present study was to report the development of patient-reported quality of life (QOL), in a patient group with musculoskeletal polytrauma, excluding patients with major thoracic, abdominal, and brain injuries.Materials and Methods: The study design was a 1-year cohort follow-up study. Recordings of injury severity were measured with the ISS and NISS. Patient-reported QOL was measured with the questionnaires Eq5d-5L and SF-36 and compared to age-matched reference populations. Moreover, patients return to work status was measured. Data were collected prospectively at discharge, 3, 6, and 12 months.Results: 53 patients were included. The mean age was 42.3 years, ranging from 17 to 78 years. Twelve months after trauma admission, the mean Eq5d-5L index was 0.601 (95 % CI 0.546-0.657). A progressive increasing Eq5d-5L index and SF-36 PCS was observed between the discharge and the 12-month follow-up (p < 0.001). The development in QOL from 6 to 12 months almost shows identically scores. Throughout the study period, patients reported significant worse QOL compared with the established reference population. 32 % of patients have resumed earlier employment status at 1-year follow-up.Conclusions: Throughout the 12-month observational period, patients reported worse QOL compared to the age-matched reference population. The development of QOL from 6- to 12-month time points almost showed identically scores with only little improvement. At the end of 1-year follow-up, 32 % of patients had resumed prior employment status. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the development in patient-reported quality of life (QOL) and muscle strength in the period from surgery to 12 months postoperatively after intramedullary nailing of a tibial shaft fracture.Materials and Methods: The design was a prospective, follow-up cohort study. QOL was measured with the questionnaire Eq5D-5L and compared to norm data from a reference population. Recordings of pain and contralateral muscle strength (isometric maximal voluntary contraction (MVC) for knee flexion and extension were collected at 6 weeks, 3, 6, and 12 months postoperatively. Ipsilateral MVCs were recorded at 6 and 12 months.Results: Forty-nine patients were included. The mean age at the time of fracture was 43.1 years (18-79 years). Twelve months postoperatively, the mean Eq5D-5L index was 0.792 (95 % CI 0.747-0.837). Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Six and 12 months after surgery patients demonstrated decreased muscle strength in the injured leg compared to the non-injured leg for knee extension and flexion (P < 0.001). Twelve months postoperatively, increasing relative difference in muscle strength during knee extension show a fair correlation to worse QOL (R = 0.541, P < 0.001).Conclusions: Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Muscle strength in the non-injured leg improved over time and was higher after 6 and 12 months compared with the injured leg. [ABSTRACT FROM AUTHOR]